Whistling in the dark
Idiom expressing confidence that something good could happen when it is not that likely
February 3, 2012 - Drs. Ekekiel Emanuel and Jeffrey Liebman, a regular contributor to the New York Times and professor of public policy at Harvard, respectively, say health insurers will disappear by 2020.
In their opening paragraph in a January 30 blog in the New York Times, “The End of Insurance Companies”, they assert:
“Here’s a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations — groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients.”
They presume this development will leave no room for insurers.
They continue,” A new system is on its way, one that will make insurance companies unnecessary.” The new system, they confidently predict, will consist of accountable care organizations, made up of collaborating hospitals and doctors." ACOs will offer bundled payments. Fee-for-service payments will cease to exist.
ACOs, the two Obamanites imply, will sprout, flourish, and metastasize across the land from sea to shining sea.
Their prediction may be bold, but I believe it is wrong.
The two former Obama advisors contend, “Accountable care organizations will increase coordination of patient’s care and shift the focus of medicine away from treating sickness and toward keeping people healthy, saving the federal government money on Medicare patients and producing better outcomes.”
We shall see.
The two may be whistling in the dark. What they are forecasting is a superb example of wishful thinking.
It rests on four flawed assumptions.
• Assumption #1 - Doctors and hospitals will flock to ACOs as an alternative to their present practices. This is unlikely. Only a handful (ten to be precise) of present physician organizations, which do not include the most prestigious in the land, have accepted the concept of ACOs. Indeed surveys indicate 67% of doctors are skeptical about ACOs. Ten “pioneer ACOs” began forming on January 1, 2012. They have yet to work out the kinks and wrinkles or to overcome the challenges and obstacles of forming workable, practical, and economical organizations. They will take years to get their act together.
• Assumption #2 - These organizations are not risk-free. ACOs pose hazards and raise questions in the minds of physicians and othr observers. Will physicians have any control over the Medicare populations covered? Will these ACO populations consist of their present patients? Will they have control over the patients' behaviors or life-styles? How much of physicians’ incomes will be at risk? Will ACOs save money? How much time and bureaucracy will be involved? Can hospitals, who often compete with physicians, be trusted as business partners? What are the chances of being audited for anti-trust if an ACO dominates a market? How much will it cost to set up ACOs - to hire the lawyers and consultants that will be required?
• Assumption #3 - ACOs will succeed. In a January 19 blog, John Goodman, founder of the National Center for Policy Analysis, says all of Medicare’s 34 pilot demonstrations to date have failed to save money or decrease costs. And in a January 25 blog, Greg Scandlen of the Health Benefits Group cites a study from the UK. The UK has invested $20 billion in HIT for its 62 million citizens since 2002. It has chosen to scrap its failed program. Why,Scandlen asks in “Whistling Past the Graveyard,” should the U.S. expect its $27 billion program, expected to cover 301 billion people, succeed?
• Assumption #4 – Why would Health Insurance plans, which together had $346 billion in revenues in 2008, meekly retreat and be unable to compete with ACOs? This industry’s revenues grew by 7% in 2009. Besides, the industry manages 21% of Medicare plans and 14% of Medicaid plans. CMS may not be able to function without health plan expertise, particularly with 10,000 to 12,000 new baby boomers becoming eligible for Medicare each day and 32 million more Medicaid recipients expected in 2014. Yet Emanuel and Liebman say “ACOs will require enhanced information systems to track patients and figure out how to deliver more effective care.”
Bulking Up Rather Than Disappearing
Instead of “disappearing,” as Emanuel and Liebman predict, it is far more likely insurers, hospitals, and physicians will consolidate into larger entities to protect themselves against government. In the words of a December 12 Wall Street Journal article, “The lines are blurring between insurance companies, hospitals, and other health-care providers.” Wellpoint, United, Highmark, and Humana have already acquired or are in process of acquiring physician-owned health groups and hospital-owned health systems.
As I wrote in a December 13, 2011, Medinnovation blog, “Building, bulging, and blurring into big boundary-less behemoths seems to be health care Master Plan ‘B’" as health care participants bulk together to bring down costs and blitzkrieg markets."
Foregive me, if you will, for the shameful alliteration and hyperactive hyperbole. But, as the poet Dylan Thomas might say, health plans are not going to go silently into that good night.
Tweet:: Drs. Emanuel and Liebman in the 1/2012 NYT boldly and wrongly predict health insurers will collapse and be replaced by ACOs by 2020.
Friday, February 3, 2012
Thursday, February 2, 2012
Power of Acronyms and Algorithms at the Point of Care:A Personal Story
For of all sad words of tongue or pen, the saddest are these: it might have been.
John Greenleaf Whittier (1807-1891), American Poet and Abolitionist, Maud Muller (1856)
Woe is me!
Isaiah, 6:5
February 2, 2012 – Let me begin at the end of my story. I conclude it is now possible to have patients enter their personal data, complaints, symptoms, and history into a computer, add laboratory data and other clinical information, crunch the information and data, and the computer will spell out in plain narrative English the differential diagnosis, treatment options, and prognosis.
Whether this process is desirable or will pass privacy, security, and legal muster is another matter altogether.
Basis for Conclusion
I base this conclusion on my personal story on a series of laboratory letters I wrote starting in 1968 and ending in 1985, which contained a series of computer-related acronyms; on a book I wrote in 2007, Innovation-Driven Health Care (Jones and Bartlett) with a chapter, “An Innovator’s Personal Experience and Vision”; and on an outpouring of 2132 (this is #2133) Medinnovation blogs I have composed from November 2007 to the present.
Or perhaps as Winston Churchill so famously said, “This is not the end. It is not even the beginning of the end. But it is the end of the beginning.”
Before I delve into my personal story, let me make this observation: the power of the computer and information technology resides at the intersection of government, entrepreneurship, and venture capitalism, and, in turn, on the integration of humanism and computer algorithms – a combination Steve Jobs, founder of Apple so brilliantly exploited and articulated.
The WOE Index
If you give the matter any thought at all, you will soon realize cumulative and weighted evidence, which I dub the WOE (Weight of Evidence) Index, is the basis for most of the chatter about evidence-based medicine, and, indeed, for the existence of the government’s Affordable Care Act agency, which goes by the non-felicitous bureaucratic acronymn of PCORI (Patient Centered Outcome Review Institute).
Acronyms
My story begins with the Internet. Here is how Wikipedia explains the history of the Internet
“The history of the Internet began with the development of computers in the 1950s. This began with point-to-point communication between mainframe computers and terminals, expanded to point-to-point connections between computers and then early research into packet switching. Packet switched networks such as ARPANET, Mark I at NPL in the UK, CYCLADES, Merit Network, Tymnet, and Telenet, were developed in the late 1960s and early 1970s using a variety of protocols.”
In the late 1960s, as co-owner of a Minneapolis-based clinical laboratory, Lufkin Medical Laboratories, with the aid of a University of Minnesota physics professor, Russell Hobbie, using an early version of the Internet, I helped write a software differential diagnosis program based on disease patterns of 700 abnormal tests performed at our clinical laboratory. The University of Minnesota computer center was one of a dozen or so University-based Internet centers founded by the U.S. goverment as communication centers in case of a Soviet nuclear attack.
Using the Univesity of Minnesota Internet center, we constructed and attached a report, Unified Presentation of Relevant Tests (UNIPORT), with every set of abnormal laboratory results. Six million of these reports, which include the top ten diagnostic possibilities, were sent out over a 5 year span and were well received by thousands of clinicians.
UNIPORT was just one of a series of acronyms I coined and described in the Lufkin Medical Laboratories Letter.
Other acronyms included.
• Diagnotes – diagnostic possibilities attached to each abnormal result, March 1970.
• SORT, which I explained, stood for the simple verb “sort and not an acronym for System of Revolutionary Technology, nor for “sortilege) A divine forecast, January 1971.
• WOE (Weight of Evidence) Index, February 1973.
• UNIPORT (Unified Presentation of Relevant Tests, March 1977.
• HQ (Health Quotient), in 1985, an algorithm calculating health status based on body measurements and vital signs, cardiovascular history, and certain laboratory data (glucose, blood lipids) with a normal range of HQ of 75 to 125, the health analogue of the IQ.
Effective for Laboratory Marketing but Not for National Business
These acronymn-named reports were effective for local laboratory marketing and were acompnied by playful commentary in my laboratory letters. But like a lot of physician entrepreneurs, I did not have the business sense or knowledge to capitalize on them for a national business enterprise. I was not alone among physicians in lacking the sense of how to organize ideas, in backing them with venture capital, and taking them to the next level of a national market. Note: Lufkin Laboratories was acquired by a national laboratory in 1985, and they discontinued our the computer programs.
Ed Roberts, MD (1942-2010), a Cochrane, Georgia family practitioner, in a former career as a biomedical engineer, came up with the idea of the personal computer. In 1974, Roberts, an employee of an Albuquerque engineering company, developed the Altair 8800, a breadbox-sized contraption that sold as a computer kit for personal use. An article appeared in January 1975 in Popular Electronic Magazine “Project Breakthrough: world’s First Microcomputer Kit to Rival Commercial Models ...Altair 8800”.
Paul Allen, Bill Gate’s sidekick, and then a Harvard undergraduate, flew to Albuquerque to see it. He told Gates what he saw, the two developed software for it, Microsoft was founded, Allen and Gates quit Harvard, and the rest is history.
Of Gates, Roberts said,”Bill is an extremely bright guy, but as far as his technical ability, he isn’t unique. He has enormous business kills. He has a genius for business.” Similarly, Steven Jobs had a business sense for integrating computer model design, with software design, with anticipation of what the public wanted but did not know what they wanted until they saw it.
My Point
My point is this. To bring an idea to market and to back it with sufficient capital, one needs to have business sense and the entrepreneurial skills to get venture capital. Capital is the oxygen of big ideas and billion dollar companies.
As Brad Feld and Jason Mendelsohn, explain in their 2011 book Venture Deals: Be Smarter than Your Lawyer and Venture Capitalist (John Wiley & Sons), the venture capital industry is of relatively recent vintage. Venture capital created many of the great technology companies starting in the 1980s - Apple, Google, Microsoft, Cisco Systems, Yahoo!, Digital Equipment Corporation, AOL, and more recently Facebook, Twitter, Linking, Zynga, and Groupon. Venture deals require multiple players - entrepreneurs, venture capitalists, angel investors, syndicate, lawyers, and mentors - and tangled layers of back-and-forth deals and control issues, starting with term sheets. Most physicians, including myself, have neither the time nor the skills nor the patience to master the art and woes of the venture deal.
Tweet: Power of humanist-IT integration resides in attention-getting acronyms and detail-rendering algorithms backed by venture capital.
John Greenleaf Whittier (1807-1891), American Poet and Abolitionist, Maud Muller (1856)
Woe is me!
Isaiah, 6:5
February 2, 2012 – Let me begin at the end of my story. I conclude it is now possible to have patients enter their personal data, complaints, symptoms, and history into a computer, add laboratory data and other clinical information, crunch the information and data, and the computer will spell out in plain narrative English the differential diagnosis, treatment options, and prognosis.
Whether this process is desirable or will pass privacy, security, and legal muster is another matter altogether.
Basis for Conclusion
I base this conclusion on my personal story on a series of laboratory letters I wrote starting in 1968 and ending in 1985, which contained a series of computer-related acronyms; on a book I wrote in 2007, Innovation-Driven Health Care (Jones and Bartlett) with a chapter, “An Innovator’s Personal Experience and Vision”; and on an outpouring of 2132 (this is #2133) Medinnovation blogs I have composed from November 2007 to the present.
Or perhaps as Winston Churchill so famously said, “This is not the end. It is not even the beginning of the end. But it is the end of the beginning.”
Before I delve into my personal story, let me make this observation: the power of the computer and information technology resides at the intersection of government, entrepreneurship, and venture capitalism, and, in turn, on the integration of humanism and computer algorithms – a combination Steve Jobs, founder of Apple so brilliantly exploited and articulated.
The WOE Index
If you give the matter any thought at all, you will soon realize cumulative and weighted evidence, which I dub the WOE (Weight of Evidence) Index, is the basis for most of the chatter about evidence-based medicine, and, indeed, for the existence of the government’s Affordable Care Act agency, which goes by the non-felicitous bureaucratic acronymn of PCORI (Patient Centered Outcome Review Institute).
Acronyms
My story begins with the Internet. Here is how Wikipedia explains the history of the Internet
“The history of the Internet began with the development of computers in the 1950s. This began with point-to-point communication between mainframe computers and terminals, expanded to point-to-point connections between computers and then early research into packet switching. Packet switched networks such as ARPANET, Mark I at NPL in the UK, CYCLADES, Merit Network, Tymnet, and Telenet, were developed in the late 1960s and early 1970s using a variety of protocols.”
In the late 1960s, as co-owner of a Minneapolis-based clinical laboratory, Lufkin Medical Laboratories, with the aid of a University of Minnesota physics professor, Russell Hobbie, using an early version of the Internet, I helped write a software differential diagnosis program based on disease patterns of 700 abnormal tests performed at our clinical laboratory. The University of Minnesota computer center was one of a dozen or so University-based Internet centers founded by the U.S. goverment as communication centers in case of a Soviet nuclear attack.
Using the Univesity of Minnesota Internet center, we constructed and attached a report, Unified Presentation of Relevant Tests (UNIPORT), with every set of abnormal laboratory results. Six million of these reports, which include the top ten diagnostic possibilities, were sent out over a 5 year span and were well received by thousands of clinicians.
UNIPORT was just one of a series of acronyms I coined and described in the Lufkin Medical Laboratories Letter.
Other acronyms included.
• Diagnotes – diagnostic possibilities attached to each abnormal result, March 1970.
• SORT, which I explained, stood for the simple verb “sort and not an acronym for System of Revolutionary Technology, nor for “sortilege) A divine forecast, January 1971.
• WOE (Weight of Evidence) Index, February 1973.
• UNIPORT (Unified Presentation of Relevant Tests, March 1977.
• HQ (Health Quotient), in 1985, an algorithm calculating health status based on body measurements and vital signs, cardiovascular history, and certain laboratory data (glucose, blood lipids) with a normal range of HQ of 75 to 125, the health analogue of the IQ.
Effective for Laboratory Marketing but Not for National Business
These acronymn-named reports were effective for local laboratory marketing and were acompnied by playful commentary in my laboratory letters. But like a lot of physician entrepreneurs, I did not have the business sense or knowledge to capitalize on them for a national business enterprise. I was not alone among physicians in lacking the sense of how to organize ideas, in backing them with venture capital, and taking them to the next level of a national market. Note: Lufkin Laboratories was acquired by a national laboratory in 1985, and they discontinued our the computer programs.
Ed Roberts, MD (1942-2010), a Cochrane, Georgia family practitioner, in a former career as a biomedical engineer, came up with the idea of the personal computer. In 1974, Roberts, an employee of an Albuquerque engineering company, developed the Altair 8800, a breadbox-sized contraption that sold as a computer kit for personal use. An article appeared in January 1975 in Popular Electronic Magazine “Project Breakthrough: world’s First Microcomputer Kit to Rival Commercial Models ...Altair 8800”.
Paul Allen, Bill Gate’s sidekick, and then a Harvard undergraduate, flew to Albuquerque to see it. He told Gates what he saw, the two developed software for it, Microsoft was founded, Allen and Gates quit Harvard, and the rest is history.
Of Gates, Roberts said,”Bill is an extremely bright guy, but as far as his technical ability, he isn’t unique. He has enormous business kills. He has a genius for business.” Similarly, Steven Jobs had a business sense for integrating computer model design, with software design, with anticipation of what the public wanted but did not know what they wanted until they saw it.
My Point
My point is this. To bring an idea to market and to back it with sufficient capital, one needs to have business sense and the entrepreneurial skills to get venture capital. Capital is the oxygen of big ideas and billion dollar companies.
As Brad Feld and Jason Mendelsohn, explain in their 2011 book Venture Deals: Be Smarter than Your Lawyer and Venture Capitalist (John Wiley & Sons), the venture capital industry is of relatively recent vintage. Venture capital created many of the great technology companies starting in the 1980s - Apple, Google, Microsoft, Cisco Systems, Yahoo!, Digital Equipment Corporation, AOL, and more recently Facebook, Twitter, Linking, Zynga, and Groupon. Venture deals require multiple players - entrepreneurs, venture capitalists, angel investors, syndicate, lawyers, and mentors - and tangled layers of back-and-forth deals and control issues, starting with term sheets. Most physicians, including myself, have neither the time nor the skills nor the patience to master the art and woes of the venture deal.
Tweet: Power of humanist-IT integration resides in attention-getting acronyms and detail-rendering algorithms backed by venture capital.
Wednesday, February 1, 2012
A Declaration of Dependence
If the American Revolution had produced nothing but the Declaration of Indpendence, it would have been worthwhile.
Samuel Eliot Morrison (1887-1976),The Oxford History of the American People
February 1, 2012- We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable Rights, that among these are Dependency, the pursuit of Unhappiness, and equal outcomes regardless of merit or work invested –That to secure these rights, Governments are instituted among Men, deriving their powers from the consent of the government – That whenever any Form of Government becomes oppressive of these ends or any class arises above the others, or accumulates Wealth beyond those of others, it is the Right of the People to alter it, amend it, and redistribute it; and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them seem most likely to effect their Dependency and Unhappiness and to correct any inequality or to allow one class to rise above Others, as judged by the present Righteous Government. The history of the past Governments is a history of repeated injuries and usurpations, all having in direct object the establishment of absolute inequality.
We, therefore, the Representatives of the United States of America, do, in the Name, and by the Authority of the good People of this Nation, solemnly publish and declare, That these United States are, have the Right and Obligation to make dependent States totally dependent, to render independent individuals or organizations dependent, That they, the present Government, be Absolved from all Allegiance to past Government, and that all political connections between them and past Rulers, ought to be totally dissolved; and that Government ought to have the Power to Bind independent States and independent individuals and to render them Dependent, that Central Government has the full Power to institute new Laws, however unpopular; to impose individual taxes for any act of Commerce, so long as they judge it to be for the Common Good and their own Good; and to do all other Acts and Things which Dependent States, made up of People dependent on Government, might do – And for the support of this Declaration, with a firm reliance on Divine Providence, we mutually pledge our Lives, the Debts of our Citizens, and their Sacred Honor to repay those Debts to whatever other country and to whomever those Debts are owed.
Tweet: The Declaration of Independence may be in danger of being replaced by a A Declaration of Dependence.
Samuel Eliot Morrison (1887-1976),The Oxford History of the American People
February 1, 2012- We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable Rights, that among these are Dependency, the pursuit of Unhappiness, and equal outcomes regardless of merit or work invested –That to secure these rights, Governments are instituted among Men, deriving their powers from the consent of the government – That whenever any Form of Government becomes oppressive of these ends or any class arises above the others, or accumulates Wealth beyond those of others, it is the Right of the People to alter it, amend it, and redistribute it; and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them seem most likely to effect their Dependency and Unhappiness and to correct any inequality or to allow one class to rise above Others, as judged by the present Righteous Government. The history of the past Governments is a history of repeated injuries and usurpations, all having in direct object the establishment of absolute inequality.
We, therefore, the Representatives of the United States of America, do, in the Name, and by the Authority of the good People of this Nation, solemnly publish and declare, That these United States are, have the Right and Obligation to make dependent States totally dependent, to render independent individuals or organizations dependent, That they, the present Government, be Absolved from all Allegiance to past Government, and that all political connections between them and past Rulers, ought to be totally dissolved; and that Government ought to have the Power to Bind independent States and independent individuals and to render them Dependent, that Central Government has the full Power to institute new Laws, however unpopular; to impose individual taxes for any act of Commerce, so long as they judge it to be for the Common Good and their own Good; and to do all other Acts and Things which Dependent States, made up of People dependent on Government, might do – And for the support of this Declaration, with a firm reliance on Divine Providence, we mutually pledge our Lives, the Debts of our Citizens, and their Sacred Honor to repay those Debts to whatever other country and to whomever those Debts are owed.
Tweet: The Declaration of Independence may be in danger of being replaced by a A Declaration of Dependence.
Tuesday, January 31, 2012
Democrats, GOP, and Public in Clash All by Themselves over Health Law
I often think it’s comical
How nature always does control
That every boy and every gal
That’s born in the world alive,
Is either a little Liberal,
Or else a little Conservative!
Sir William Gilbert (1836-1911), Iolanthe (1882)
January 31, 2012- According the latest Kaiser tracking poll, 73% of Republicans view the health law unfavorably while 62% of Democrats favor it.
That’s clear enough. But wait a minute. What does the public think?
Well, like the alcoholic who lurches from left to right to stay upright in the center of his gait, the public is tottering in a clash all by itself.
The Kaiser tracking poll indicates:
• Only 37% have a favorable view of the law.
• 44% have an unfavorable view of the Affordable Care Act.
• 31% want to expand the current law while 19% want to keep it in its current form.
• 22% want it repealed outright and another 18% want it replaced with a Republican alternative—a total of 40%, fewer than the 50% want to expand it or keep it as it is.
• 67% have an unfavorable view of the individual mandate requiring everyone to buy coverage, while 30% have a favorable view of the requirement.
• While 50% of those surveyed think the law should be kept or expanded, 54% say the Supreme Court should throw the mandate out, while only 17% say they think the mandate should be upheld.
To Summarize
To summarize, only 37% have a favorable view of the law, and 67% don’t like the mandate. But 50% think the law should be kept as it is or even expanded.
What to Do
What to do politically? President Obama says there’s no going back. Republicans insist it should be repealed and replaced. The schizophrenic public wants it repealed, replaced, and expanded in one fell swoop.
Republican Grab Bag
Republicans offer a free-market grab bag.
• Malpractice reform, which Democrats, whose #1 contributor is the Trial Lawyers Association, will never accept.
• Health Savings Accounts, which depends on consumer responsibility and wisdom, something which Democrats think ordinary people lack.
• Universal tax credits, which makes so much sense it will never fly.
• Individual ownership of plans, which leaves employers out.
• Selling plans across state lines with doctors and hospitals and health plans competing, which smacks of free market competition, anathema to liberal elites.
• High risk pools for those with pre-existing illnesses, which is popular but not among all conservatives.
• Continued closure of Donut Hole and coverage of young adults under parents plans, which everyone seems to like.
Solutions
Solutions? Let the Supreme Court decide. Let liberals argue gutting Medicare of $575 billion will save it. Let Conservatives argue changing Medicare through premium vouchers will save it.
Let the public decide in November as they stagger to the polls – Liberals to the left of them, Conservatives to the right of them, Moderates and Independents dead ahead of them.
Tweet: According to the latest Kaiser tracking poll, the public would like the health law repealed, replaced, and expanded – at the same time.
How nature always does control
That every boy and every gal
That’s born in the world alive,
Is either a little Liberal,
Or else a little Conservative!
Sir William Gilbert (1836-1911), Iolanthe (1882)
January 31, 2012- According the latest Kaiser tracking poll, 73% of Republicans view the health law unfavorably while 62% of Democrats favor it.
That’s clear enough. But wait a minute. What does the public think?
Well, like the alcoholic who lurches from left to right to stay upright in the center of his gait, the public is tottering in a clash all by itself.
The Kaiser tracking poll indicates:
• Only 37% have a favorable view of the law.
• 44% have an unfavorable view of the Affordable Care Act.
• 31% want to expand the current law while 19% want to keep it in its current form.
• 22% want it repealed outright and another 18% want it replaced with a Republican alternative—a total of 40%, fewer than the 50% want to expand it or keep it as it is.
• 67% have an unfavorable view of the individual mandate requiring everyone to buy coverage, while 30% have a favorable view of the requirement.
• While 50% of those surveyed think the law should be kept or expanded, 54% say the Supreme Court should throw the mandate out, while only 17% say they think the mandate should be upheld.
To Summarize
To summarize, only 37% have a favorable view of the law, and 67% don’t like the mandate. But 50% think the law should be kept as it is or even expanded.
What to Do
What to do politically? President Obama says there’s no going back. Republicans insist it should be repealed and replaced. The schizophrenic public wants it repealed, replaced, and expanded in one fell swoop.
Republican Grab Bag
Republicans offer a free-market grab bag.
• Malpractice reform, which Democrats, whose #1 contributor is the Trial Lawyers Association, will never accept.
• Health Savings Accounts, which depends on consumer responsibility and wisdom, something which Democrats think ordinary people lack.
• Universal tax credits, which makes so much sense it will never fly.
• Individual ownership of plans, which leaves employers out.
• Selling plans across state lines with doctors and hospitals and health plans competing, which smacks of free market competition, anathema to liberal elites.
• High risk pools for those with pre-existing illnesses, which is popular but not among all conservatives.
• Continued closure of Donut Hole and coverage of young adults under parents plans, which everyone seems to like.
Solutions
Solutions? Let the Supreme Court decide. Let liberals argue gutting Medicare of $575 billion will save it. Let Conservatives argue changing Medicare through premium vouchers will save it.
Let the public decide in November as they stagger to the polls – Liberals to the left of them, Conservatives to the right of them, Moderates and Independents dead ahead of them.
Tweet: According to the latest Kaiser tracking poll, the public would like the health law repealed, replaced, and expanded – at the same time.
Monday, January 30, 2012
Tech-Led Health Care Boom?
There is always gloom for improvement.
Optimist's Maxim
January 30. 2012 – In health care and elsewhere, these are days of gloom, even doom. Costs are high, the future is uncertain, the SGR may cut doctor fees by 27.4%, physician shortages loom, reform may be unconstitutional. For the nation as a whole, the national deficit will soon exceed $16 trillion, more than the GDP, and the economy grew an anemic 1.7% in 2011. The bloom is off the U.S. rose.
In the face of all of this, Mark P. Mills, founder of the Digital Power Group, and Julio M. Ottino, dean of Engineering and Applied Science at Northwestern, say in today's Wall Stree Journal, "The Tech-Led Boom," that the U.S. is on the cusp of an unprecedented technologically-led economic boom.
These two high-tech prophets, who seem oblivious of health care gloom, predict three “three grand high tech transformations” are upon us and are centered in America - big data, smart manufacturing, and the wireless revolution.
• Big Data - Virtually free computer processing power and data shortage make this transformation inevitable. The I-phone, they note, has computing power that shames IBM mainframes, the Internet is ascending into the “cloud,” and limitless data distribution with metadata analyses assures a medical revolution in outcomes, say they.
• Smart manufacturing - Automation and information systems, they assert, will streamline supply-chain management, and in the process, will optimize product features, and will radically improve quality and reduce waste. Computer design and engineering will create new devices and products.
• Wireless revolution – Soon most humans on the planet will be connected wirelessly – everywhere, everyone, all the time. This wirelessness will fuel economic growth in our youthful, dynamic, diverse culture. America, the authors claim, has “incontrovertibly powerful features “ – open mindedness, risk-taking, hard work, playfulness, anti-establishmentarism, a penchant for critical thinking, and more than half of the world’s top universities.
Given the proper political leadership, liquid financial markets, sensible tax and immigration policies, and balanced regulations , America will innovate and it will boom, for we are an exceptionally gifted and blessed nation.
Mills and Ottino conclude:
“America’s success isn’t foreordained. But technological innovations circa 2012 are profound. They will engender sweeping changes in our society and our economy. All the forces are in place. It’s just a matter of when.”
I pray they are right. There is gloom for improvement in health care and elsewhere.
Tweet: Three high tech forces and U.S. strengths– big data, smart manufacturing, and wireless technologies – forecast a bright America future.
Optimist's Maxim
January 30. 2012 – In health care and elsewhere, these are days of gloom, even doom. Costs are high, the future is uncertain, the SGR may cut doctor fees by 27.4%, physician shortages loom, reform may be unconstitutional. For the nation as a whole, the national deficit will soon exceed $16 trillion, more than the GDP, and the economy grew an anemic 1.7% in 2011. The bloom is off the U.S. rose.
In the face of all of this, Mark P. Mills, founder of the Digital Power Group, and Julio M. Ottino, dean of Engineering and Applied Science at Northwestern, say in today's Wall Stree Journal, "The Tech-Led Boom," that the U.S. is on the cusp of an unprecedented technologically-led economic boom.
These two high-tech prophets, who seem oblivious of health care gloom, predict three “three grand high tech transformations” are upon us and are centered in America - big data, smart manufacturing, and the wireless revolution.
• Big Data - Virtually free computer processing power and data shortage make this transformation inevitable. The I-phone, they note, has computing power that shames IBM mainframes, the Internet is ascending into the “cloud,” and limitless data distribution with metadata analyses assures a medical revolution in outcomes, say they.
• Smart manufacturing - Automation and information systems, they assert, will streamline supply-chain management, and in the process, will optimize product features, and will radically improve quality and reduce waste. Computer design and engineering will create new devices and products.
• Wireless revolution – Soon most humans on the planet will be connected wirelessly – everywhere, everyone, all the time. This wirelessness will fuel economic growth in our youthful, dynamic, diverse culture. America, the authors claim, has “incontrovertibly powerful features “ – open mindedness, risk-taking, hard work, playfulness, anti-establishmentarism, a penchant for critical thinking, and more than half of the world’s top universities.
Given the proper political leadership, liquid financial markets, sensible tax and immigration policies, and balanced regulations , America will innovate and it will boom, for we are an exceptionally gifted and blessed nation.
Mills and Ottino conclude:
“America’s success isn’t foreordained. But technological innovations circa 2012 are profound. They will engender sweeping changes in our society and our economy. All the forces are in place. It’s just a matter of when.”
I pray they are right. There is gloom for improvement in health care and elsewhere.
Tweet: Three high tech forces and U.S. strengths– big data, smart manufacturing, and wireless technologies – forecast a bright America future.
Sunday, January 29, 2012
Robots in Medicine
The world of the future will be an ever demanding struggle against the limitations of our intelligence, not a comfortable hammock in which we can lie down to be waited upon by our robot slaves.
Norbert Wiener (1894-1964), God and Golem, Inc. (1964)
January 29, 2012
About robots in medicine
I ponder
And I wonder
Are robots desirable
Are robots better
Will touching
Feeling
Listening
Smelling
Palpating
And Handling
Become obsolete
Will everything be
automatic
systematic
monochromatic
It is possible
Robots do things
The same way
Every time
Real time
Robots do not deviate
From the straight
And narrow
Algorithms think like robots
Robots are checklists of the mind
IBM might tell us
Robots are E-lementary
My Dear Watson
Robotic surgery is
Purportedly
And reportedly
Safer
More predictable
Less invasive
Produces faster recoveries
Reaches inaccessible places
Reduces hospital infections
Hospital marketers love robots
Specialists love new tech, high tech
The media and the public
Love breakthrough news
But I keep thinking
Humans design robots
And therefore
Robots have
Blind spots
And soft spots
And so I wonder
Will robots ever
Think outside the box
Are robots replacements
Or merely human assistants
Maybe, just maybe, robots
Being ever consistent
And error resistant
Will protect us from human terrors
And stretcher-bearers.
Sources
1. “What’s Wrong with the da Vinci Robot?”, Health Leaders Media, January 26, 2012
2. “Robot Cleaners a ‘Game-Changer’ for Hospital Infection Epidemic”, Health Leaders Media, January 27, 2012
Tweet: Maybe robots, being ever consistent and error resistant, will protect us from health care errors and human stretcher bearers.
Norbert Wiener (1894-1964), God and Golem, Inc. (1964)
January 29, 2012
About robots in medicine
I ponder
And I wonder
Are robots desirable
Are robots better
Will touching
Feeling
Listening
Smelling
Palpating
And Handling
Become obsolete
Will everything be
automatic
systematic
monochromatic
It is possible
Robots do things
The same way
Every time
Real time
Robots do not deviate
From the straight
And narrow
Algorithms think like robots
Robots are checklists of the mind
IBM might tell us
Robots are E-lementary
My Dear Watson
Robotic surgery is
Purportedly
And reportedly
Safer
More predictable
Less invasive
Produces faster recoveries
Reaches inaccessible places
Reduces hospital infections
Hospital marketers love robots
Specialists love new tech, high tech
The media and the public
Love breakthrough news
But I keep thinking
Humans design robots
And therefore
Robots have
Blind spots
And soft spots
And so I wonder
Will robots ever
Think outside the box
Are robots replacements
Or merely human assistants
Maybe, just maybe, robots
Being ever consistent
And error resistant
Will protect us from human terrors
And stretcher-bearers.
Sources
1. “What’s Wrong with the da Vinci Robot?”, Health Leaders Media, January 26, 2012
2. “Robot Cleaners a ‘Game-Changer’ for Hospital Infection Epidemic”, Health Leaders Media, January 27, 2012
Tweet: Maybe robots, being ever consistent and error resistant, will protect us from health care errors and human stretcher bearers.
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